Shared decision-making in medicine
[16] A key means of reducing this unwarranted variation was to recognise "the importance of sound estimates of outcome probabilities and on values that corresponded closely to patient preferences".
[18] The Dartmouth Institute for Health Policy and Clinical Practice consequently made shared decision-making a key element of their program of work.
Informed consent is at the core of shared decision-making,[24][25] i.e. without fully understanding the advantages and disadvantages of all treatment options, patients cannot engage in making decisions.
Thus in certain situations the physician's point of view may differ from the decision that aligns most with the patient's values, judgments, opinions, or expectations about outcomes.
Another study found that age was not inversely related to participation levels but that patients who are not as fluent with numbers and statistics tended to let their physicians make medical decisions.
In general, for example, Americans play a more active role in the physician-patient relationship, such as by asking follow-up questions and researching treatment options, than do Germans.
[28] Researchers Arora and McHorney posit that finding may be the result of their apprehension when it comes to health-related concerns among those who place a high value on health, leading to a tendency to let an expert, rather than themselves, make important medical decisions.
[28] There is mounting evidence that giving patients real-time, unfettered access to their own medical records increases their understanding of their health and improves their ability to take care of themselves.
[39] In the context of mammography screening, physicians' message delivery styles such as how they articulated relative versus absolute risk numbers had also influenced patients' perceptions towards shared decision-making.
[30] Elwyn et al. described a set of competences for shared decision-making, consisting of the following steps a) defining the problem which requires a decision, b) the portrayal of equipoise (meaning that clinically speaking there is little to choose between the treatments) and the uncertainty about the best course of action, leading to c) providing information about the attributes of available options and d) supporting a deliberation process.
[page needed][56] The International Patient Decision Aid Standards (IPDAS) Collaboration, a group of researchers led by professors Annette O'Connor in Canada and Glyn Elwyn in the United Kingdom, has published a set of standards, representing the efforts of more than 100 participants from 14 countries around the world to will help determine the quality of patient decision aids.
[57] The IPDAS standards assist patients and health practitioners to assess the content, development process, and effectiveness of decision aids.
According to IPDAS, certified decision aids should, for example, provide information about options, present probabilities of outcomes, and include methods for clarifying patients' values.
The previous authors also presented a model for life-critical SDM which is based on multi-attribute utility theory (MAUT) and the QALYs (quality-adjusted life years) concept.
Based on studies of barriers to shared decision-making as perceived by health professionals[64] and patients,[65] many researchers are developing sound, theory-based training programs and decision aids, and evaluating their results.
Canada has established a research chair that focusses on practical methods for promoting and implementing shared decision-making across the healthcare continuum.
[70] The rationale for these new policies ranges from respect for consumer or patient rights to more utilitarian arguments such as that shared decision-making could help control health care costs.
Training health professionals in shared decision-making attracts the attention of policy makers when it shows potential for addressing chronic problems in healthcare systems such as the overuse of drugs or screening tests.
One such program, designed for primary care physicians in Quebec, Canada, showed that shared decision-making can reduce use of antibiotics for acute respiratory problems (earaches, sinusitis, bronchitis, etc.)
[76] This is part of the wider ambition to promote patient-centred care, to increase patient choice, autonomy and involvement in clinical decision-making and make "no decision about me, without me" a reality.
In 2012, the programme entered an exciting new phase and, through three workstreams, is aiming to embed the practice of shared decision-making among patients and those who support them, and among health professionals and their educators.
[77] One of the components of the National Programme is the work of the Advancing Quality Alliance (AQuA),[78] who are tasked with creating a receptive culture for shared decision-making with patients and health professionals.
[87][88][89][86][90] Almario et al.[88] found rather high patient-reported scores of physicians' interpersonal skills (DISQ,[91] ~89 of 100) and SDM (SDM-Q-9,[92] ~79–100) with no significant differences between trial arms.
Tai-Seale et al.[93] used one item on physician respect (CAHPS)[94] and found similarly positive evaluations reported by 91–99% of participants in each of the four study arms.
[101] Shared decision-making is also now being applied in areas of healthcare that have wider social implications, such as decisions faced by the frail elderly and their caregivers about staying at home or moving into care facilities.
They take action to improve the quality of their life and have the necessary knowledge, skills, attitudes and self-awareness to adjust their behavior and to work in partnership with others where necessary, to achieve optimal well-being.
Additionally, the findings of another study indicate that the use of a cardiovascular risk calculator led to increased patient participation and satisfaction with the treatment decision process and outcome and reduced decisional regret.
[127][128] There is currently limited evidence to form a robust conclusion that involving older patients with multiple health conditions in decision-making during primary care consultations has benefits.
[131] A recent study revealed that SDM description, clarification and recommendations in CPGs and CSs concerning breast cancer treatment were poor, leaving a large scope for improvement in this area.
[126] Many researchers and practitioners in this field meet every two years at the International Shared Decision Making (ISDM) Conference, which have been held at Oxford (2001), Swansea (2003), Ottawa (2005), Freiburg (2007), Boston (2009), Maastricht (2011), Lima (2013), Sydney (2015),[132] Lyon (2017), Quebec City (2019), and Kolding, Denmark (2022).
